Questionnaire for Intended Parents

Name of the Intended Father

Name of the Intended Mother

Official Address

Postal Address

Country

Skype

Viber

In case that we cannot reach you in the above given email/phonenumber/etc., is there an alternative way to communicate with you in case of an emergency? (If yes, please write the alternative way to connect with you):

Health Questions

Have you had any IVF attempts previously? Please, describe such previous attempts (used methods, number of attempts, etc.):

Why are you interested in a Surrogacy Program?

If it is because of a medical issue, is the condition fatal? In other words, would there be a likelihood that the child would lose its parents?

Surrogacy Issues

When do you plan to start the program?

Do you plan to you use a donor of oocytes or are you able to provide your own oocytes?

What are your feelings on becoming the parents of twins?

What are your feelings on abortion if it was found that your child has birth defects?

What is your degree of commitment to the Surrogacy Program? (please, specify from 1 to 10)

Financial Questions

Are you aware of the costs associated with surrogate motherhood? Are you in a financial position to be able to meet the costs of a surrogacy program?

A Surrogacy Program is a highly personalized and complex program that demands a great deal of coordination, organization and preparative work. Are you aware of the serious prejudices for donor, surrogate mother, doctors, and assistants in case that you don’t meet up in the agreed date and time for the start of the program?

After Pregnancy

What kind of future contact do you foresee having with your surrogate mother?

Pons Medical Research

Health Questions

Surrogacy Issues

Financial Questions

After Pregnancy